Modern surgical procedures are increasingly utilizing complex surgical tools such as robots, computer assisted instruments, multifunctional instruments, and other devices that utilize enhanced control systems (ECS). Enhanced control systems are systems that consist of mechanical or electromechanical configurations and that may provide one or more endo-mechanical features that provide a surgeon with improved surgical end effector mobility. Examples of improvements include increased instrument flexibility, better ergonomic positioning, hand tremor reduction, translation of motion frames of reference, telesurgery, including robotic systems and the like. ECS typically involves more elaborate instruments and support structures for the instruments compared to typical laparoscopic surgery and may also include the use of novel body entry devices and different points of entry compared to laparoscopic or other minimally invasive surgical techniques. Many of these enhanced control devices utilize in some form a flexible endoscope as the primary method for accessing areas of the body. Flexible endoscopes typically have a primary channel where a camera is located along with lighting fibers. The endoscopes also have additional channels (also called operating or working lumens) for transversing instruments through the endoscope and emerging out at the end of the endoscope proximate to the surgical site. One or more of the instruments can then be utilized or otherwise controlled for surgical tissue applications.
In systems that utilize an endoscope or other flexible device, the scope itself is flexible and thus the lumens that are contained within the scope for the insertion of instruments, are also flexible. The scopes are generally manipulated into a position where the camera can view the area of interest. The scope can then be “locked” into this position (if the design permits) or simply held. Auxiliary instruments are then guided down the operating lumens while the scope is held in position. Since the scope is bent and/or otherwise curved in varying angles, the internal lumens are also bent. Therefore, as an instrument is inserted down the working lumen, any rigid parts of the instrument must pass through the radius/radii of the bent lumen. Therefore, the radii of any bends in the lumen necessarily limit the length of the inserted instrument. The diameter of the lumen itself also limits the size of the instrument. For example, the length and size of a jaw and instrument housing may be limited. In some cases the endoscope can be straightened when exchanging instruments allowing for longer instrument jaws to be inserted, but this is not desirable since the field of interest will have to be re-established once the instrument is through the lumen. Locating the endoscope back into the previous position can be very time consuming and dangerous.
Since the jaws of the instruments used for these procedures, which can include single orifice procedures, scar-less procedures, and single port of entry procedures, are limited in length, the function of the associated end effectors may be compromised. For example, a grasper inserted into a lumen of this type cannot manipulate as much tissue as other graspers since the jaw length will be much shorter (to accommodate passing through the curved sections of the lumen) than the grasper jaw length normally used in a minimally invasive surgical procedure. In order to achieve a longer, more conventional jaw length while still allowing the instrument to transverse down a flexible scope's working lumen, the jaws and other end effectors used with these surgical instruments need to be modified.
In addition, incorporating a multi-function end effector into a single instrument will eliminate or at least decrease the requirement that one instrument be removed and exchanged for a second instrument when a second instrument is needed during a minimally invasive procedure and can also serve to reduce the dimensional profile of the end effector, allowing easier passage through a curved lumen. Eliminating or substantially decreasing instrument exchange may save valuable time during a surgical procedure, allowing a health professional to perform other critical functions.
What is needed is a surgical tool that can accommodate an end effector having multiple functions and that can transverse or otherwise pass through a flexible lumen.